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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two recipients of orthotopic liver transplants (OLT) underwent intra-arterial thrombolytic treatment for hepatic artery thrombosis. Complete clot lysis was achieved in both using infusion of high-dose urokinase directly into the thrombus for 12 and 3 hours, respectively. Percutaneous transluminal angioplasty (PTA) was later carried out successfully on various strictures. Doppler ultrasonography confirmed arterial permeability one month after treatment. Liver transplantation is now an accepted therapeutic option in some patients with irreversible liver failure. Although the results of this procedure have improved radically since cyclosporine was introduced in 1978, life-threatening postoperative complications still occur. The one with the worst prognosis is hepatic artery thrombosis (HAT), with 64% mortality despite retransplantation. HAT was found in 7.4% of liver transplant recipients in a recent review of the most important group of these patients. Fibrinolytic treatment using an exogenous plasminogen activator, urokinase (UK), is effective and safe in the thrombotic obstruction of acute pulmonary embolism, acute myocardial infarction, and graft or peripheral arterial occlusion. We used intra-arterial thrombolysis in two patients with HAT of the liver graft, to avoid retransplantation and to treat a complication secondary to percutaneous transluminal angioplasty (PTA) of an anastomotic stricture, respectively. To our knowledge, this is the first report of treatment of HAT by direct infusion of urokinase in liver transplantation.
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PMID:High-dose intra-arterial urokinase for the treatment of hepatic artery thrombosis in liver transplantation. 261 76

The difficulty in making an accurate diagnosis of acute pulmonary embolism is well known. To clarify the role of echocardiography, including Doppler echocardiography, in acute pulmonary embolism, we examined hemodynamic and echocardiographic parameters in 9 patients with acute pulmonary embolism just before and after treatment with urokinase. As hemodynamic parameters normalized after treatment, echocardiographic parameters such as deformity index of the left ventricle (LV-DI), end-diastolic dimension of the right ventricle (RVDd), the left ventricle (LVDd), the inferior vena cava, and RVDd/LVDd all significantly changed toward normal. Highly significant correlations were found between the echocardiographic and hemodynamic parameters, the best of which was between the LV-DI and systolic pulmonary artery pressure (r = -0.885, p less than 0.001). Doppler echocardiography quantitatively evaluated the grade of tricuspid regurgitation, and accurately estimated systolic pulmonary artery pressure. We conclude that echocardiography, including Doppler echocardiography, sensitively reflects the right ventricular pressure and volume overload of acute pulmonary embolism, is quite useful for its diagnosis which is often difficult, and is suitable for noninvasive follow up of these patients.
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PMID:Role of echocardiography in acute pulmonary embolism. 261 28

A 78-year-old woman, suffering from acute massive pulmonary embolism, was successfully treated with transvenous pulmonary embolectomy by catheter. This patient had been suffering from oppressive chest sensations during exercise, and diagnosed and treated as angina pectoris at a nearby clinic. She consulted our hospital complaining that her chest pains were increasing in frequency. She was admitted to our hospital on July 7, 1988, for coronary angiography (CAG), which she underwent on July 8 by the right femoral approach. After the CAG, she was ordered to rest in bed overnight, with the right inguinal region compressed. 18 hours later, the compression was removed and she was allowed to walk. Soon after she walked to the toilet, she complained of chest discomfort and fell into shock (systolic blood pressure was 60 mmHg). An ECG examination showed a right bundle branch block and an inverted T wave in lead V1-3. An echocardiography showed normal contraction of the left ventricle, but an enlargement of the right ventricle and a flattened interventricular septum. An analysis of arterial blood gas showed hypoxia (Pao2 52.5 mmHg, Paco2, 30.9 mmHg). Acute pulmonary embolism was suspected. 240,000 units of urokinase were administered intravenously, and pulmonary angiography was performed immediately. It revealed that the bilateral pulmonary arteries were almost completely obstructed. Although 720,000 units of urokinase were infused into the pulmonary artery, the obstruction did not improve. At that time, we performed a transvenous pulmonary embolectomy. We used a Judkins R 4 guiding catheter for PTCA made by USCI. The catheter was inserted into the pulmonary artery and clots were aspirated with a syringe.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of acute massive pulmonary embolism successfully treated with transvenous pulmonary embolectomy by catheter]. 261 14

After a brief mention of new advances in the pathophysiology of fibrinolysis, the authors outline the pharmacological properties of the new thrombolytic agent rt-pA versus classic thrombolytic agent urokinase and streptokinase. Thereafter they report a case of acute pulmonary embolism with severe hypoxemia in a patient with a history of recent traumatic cerebral bleeding. Thrombolytic treatment with rt-pA (100 mg/2 h) resulted in a satisfactory clinical outcome without appreciable worsening of intracranial injury.
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PMID:[A clinical case of pulmonary thromboembolism in a patient at risk treated with rt-pA]. 263 76

It has been shown in animals that acute obstruction of pulmonary artery branches is followed by an early but shortly lived increase in blood levels of thromboxane B2 and a subsequent longer-lasting increase in blood levels of 6-keto-PGF1 alpha. Our study was conducted on twelve patients with acute pulmonary embolism. Nine were treated with urokinase; three could not be given thrombolytic or anticoagulant drugs due to bleeding peptic ulcer (2 cases) or recent cerebral hemorrhage (1 case). HPLC and RIA tests were performed on arterial blood samples at diagnosis and after 1, 6, 12 and 24 hours. Findings were compared with those in a control group of 6 healthy subjects. There was a difference in prostanoid behaviour between the untreated and urokinase treated patients. Among the former mean TxB2 was significantly raised at clinical onset and began to decline after 6-12 hours, approaching the mean level found among the controls after 24 hours. In contrast 6-keto-PGF1 alpha was raised after 1 hour and gradually declined thereafter. In the subjects treated with urokinase TxB2 was already close to the mean control level after 1 hour; 6-keto-PGF1 alpha had increased after 1 hour but had returned near the control level after 12. The behaviour of prostanoids appears to match the clinical course.
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PMID:The release of thromboxane B2 and 6-keto-PGF1 alpha following pulmonary embolism. 263 7

The ability of streptokinase and urokinase to lyse intravascular fibrin-based clots is firmly established. However, there is a lack of enthusiasm for these agents because of serious haemorrhagic complications and a lack of controlled randomized studies indicating their efficacy. Thrombolytic therapy is suitable in only 15 per cent of patients with acute deep venous thrombosis. It restores the venous circulation to normal in up to 95 per cent of these patients if therapy is instituted within 5 days of the onset of symptoms. These patients have significantly fewer symptoms on follow-up than patients treated with heparin although the ability of thrombolytic therapy to preserve venous valvular function and to prevent the post-phlebitic syndrome is now in question. Thrombolytic therapy is as effective as heparin in preventing pulmonary embolism and may be superior in its treatment. Pulmonary haemodynamics are rapidly improved, diffusion capacity is restored and, although the evidence is inconclusive, long-term pulmonary hypertension may be prevented. Although the mortality rate is not decreased, controlled studies show that thrombolytic therapy may be beneficial in massive pulmonary embolism with clinical shock. Thrombolytic therapy is indicated for acute arterial and acute bypass graft occlusion when the surgical alternative is associated with a higher morbidity and mortality. Partial thrombolysis is achieved in up to 90 per cent of cases and the need for further therapeutic intervention is eliminated in one-third of the patients treated. New thrombolytic agents with greater specificity and potentially greater efficacy and fewer complications are being developed. Tissue plasminogen activator has been successfully used. Prourokinase, fibrin-seeking urokinase and acetylated streptokinase-plasminogen complex may expand the role of thrombolytic therapy in surgical practice.
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PMID:The role of thrombolytic therapy in surgical practice. 265 13

We report the clinical, echocardiographic and therapeutic aspects and the evolution of 7 cases of right cardiac migrant thromboembolus in pulmonary embolism (5 M and 2 F, aged 43 to 91). Our data are also compared with all the cases reported in the literature (77 patients). During a sample year (1987) we systematically performed two-dimensional echocardiograms (2D Echo) as early as possible in all the patients admitted to our Coronary Care Unit for suspected pulmonary embolism; among 42 patients the diagnosis of pulmonary embolism was confirmed in 30 out of 42 patients. A relatively high incidence of thromboembolus was found (5/30, 17% in 1987); this finding seems to be relative to the early execution of the 2D Echo study (thromboembolus was found in 4/5 patients when 2D Echo was performed within 20 hours and in only 1/23 when 2D Echo was performed later). The 2D Echo was always evocative of freely floating migrant thromboembolus (6 in right atrium, 1 in right ventricle) and no differential diagnosis with thrombi in situ or other masses was necessary. The therapy for 6 patients hospitalized for pulmonary embolism and surviving the first hours (1 patient died immediately) was: surgical in 1 case, medical in the other 5. Medical therapy consisted only of heparin-calcium in one patient and heparin-calcium + dipyridamole in another because of contra-indications for more aggressive therapy. One patient underwent anticoagulant therapy with i.v. heparin. The remaining two underwent fibrinolytic therapy with urokinase and, afterwards, anticoagulant therapy: in 1 case the therapy was started after the embolization of the mass in the pulmonary artery had occurred; in the other one we observed the progressive reduction of thromboembolus until its disappearance within 5 days without any signs of further embolization. All patients survived and were discharged within 25 days, despite the occurrence of lung embolization in 4 of them. The review of 77 cases reported in the literature shows good outcomes for embolectomy when compared with medical therapy, but almost half of the patients underwent surgical therapy directly. Medical therapy experience, particularly with thrombolytic agents (10 cases in all), is still too scarce to exclude its role, as indeed our experience seems to indicate.
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PMID:[Thromboembolus migrating into the right heart in pulmonary embolism. Echocardiographic and clinico-therapeutic aspects in 7 cases and review of the literature]. 266 84

Post-operative thrombo-embolic disease remains a frequent occurrence in spite of advances in their prophylaxis. Evaluation of 60 case-reports of this disease which often includes peripheral manifestations and always pulmonary manifestations, enables to specify the role of the procedure itself (mostly orthopaedic surgery 60%), pelvic surgery 20%, the chronology of events (possibility of early embolism between D1 and D3 and usual occurrence of manifestations between D8 and D18, and the importance of the background, whether investigated or not: deficiencies in anti-thrombin III, protein C and S: 4 cases. The diagnosis is based on clinical signs (non-specific) and the laboratory tests, especially scintigraphy (screening) and angiography, absolutely necessary for the diagnosis and evaluation of the amputation coefficient (Miller index). With a diagnosis of pulmonary embolism, it is always necessary to look for a proximal venous thrombosis. The treatment, calls for heparin (quite seldom), thrombolytics (Urokinase, Plasminogen in our experience), the indication of which must take into consideration the delays and the nature of the previous procedure, and finally surgery (massive forms where thrombolytics are contraindicated). The thrombo-embolic manifestations with thrombogenic thrombopenia secondary to heparin are quite frequent, in a surgical environment (10 cases) and difficult to treat.
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PMID:[Postoperative pulmonary embolism]. 266 1

Clinical experience with thrombolytics in non-coronary disorders is limited to the plasminogen activators streptokinase, urokinase and alteplase; therapeutic trials with anistreplase (APSAC) are almost, and with saruplase completely, limited to acute myocardial infarction. In terms of thrombus clearance, thrombolytic drugs are superior to heparin in patients with recent deep vein thrombosis in the pelvis or lower limbs. In aggregate, thrombi younger than 8 days are lysed in approximately 60% of patients treated with streptokinase, urokinase or alteplase. The results of studies assessing the subsequent development of the postphlebitic syndrome are conflicting, but most suggest that thrombolytic therapy can reduce symptoms of chronic venous insufficiency. Currently, the combination of systemic thrombolytic drugs followed by heparin is recommended for patients with acute major pulmonary embolism who are haemodynamically unstable. Streptokinase, urokinase and alteplase have all been shown to accelerate the lysis of pulmonary emboli and to decrease pulmonary vascular obstruction and pulmonary hypertension. Systemic venous or intrapulmonary infusions of alteplase offers the same benefit in terms of angiographic and haemodynamic improvement. A short infusion of 100 mg alteplase over 2 hours seems to be superior to a 24-hour infusion of urokinase. None of the thrombolytic trials in pulmonary embolism have been large enough to demonstrate a reduction in mortality. It is now generally accepted that, unless contraindicated, thrombolytic therapy is the front-line treatment for patients with massive pulmonary embolism and major haemodynamic disturbance. The local treatment of acute arterial occlusion in limb arteries results in rapid clearing of the artery in 67% of patients treated with streptokinase; the corresponding success rates for urokinase and alteplase are 81% and 88 to 94%, respectively. The main question appears to be the identification of patients in whom local thrombolysis is the treatment of choice, as opposed to established therapeutic modalities. Thrombolytic treatment following a major ischaemic stroke is hazardous, although clinical improvement has been noted in a minority of patients with recanalised cerebral arteries. The safety and efficacy of thrombolytic treatment remains unproven for this indication, and its use must be restricted to experimental protocols. Thrombolytic treatment in retinal artery or vein occlusion has, in practice, been abandoned.
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PMID:Use of thrombolytic drugs in non-coronary disorders. 268 38

Various interventions are available to assist in the management of patients with pulmonary embolism. Most are reserved for patients who either fail standard systemic anticoagulation therapy or are not candidates for anticoagulant therapy. The most common intervention is placement of a vena caval filter. Several different filter devices are available, most of which may be placed percutaneously. Pulmonary thrombolysis with urokinase or streptokinase may be appropriate in some patients with severe, symptomatic pulmonary embolism. Finally, pulmonary embolectomy by means of either a transvenous catheter or surgical technique may be necessary in cases of refractory cardiovascular collapse.
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PMID:Interventions in pulmonary embolism. 269 5


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